Post-cardiac injury syndrome

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Synopsis

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Post-cardiac injury syndrome is a heterogeneous collection of conditions, all of which involve an inciting cardiac injury followed by the development of pericardial inflammation with or without the development of a pericardial effusion. These conditions include post-myocardial infarction syndrome, postpericardiotomy syndrome, and posttraumatic pericarditis.

The exact incidence of post-cardiac injury syndrome is unclear due to the heterogeneous nature of the condition. More is known for specific etiologies. Post-myocardial infarction pericarditis is thought to occur in less than 5% of cases. Most occur peri-infarction, with less than 1% of cases as late post-myocardial infarction pericarditis (Dressler syndrome). After percutaneous coronary intervention, the rate of post-myocardial injury pericarditis it is believed to be less than 0.5%. In comparison, the rate of postpericardiotomy pericarditis ranges between 10% and 40%.

The exact pathogenesis of this condition is incompletely understood and is believed to be autoimmune in nature.

The majority of patients will present with chest pain (>80%), often pleuritic in nature. Low-grade fever is seen in slightly over half of patients (50%-60%), as is dyspnea (50%-60%). Inflammatory markers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) are elevated, and pericardial effusions are common but often mild. A pericardial rub is auscultated in 30%-60% of cases and electrocardiogram (ECG) changes are identified in 20%.